格列美脲与格列本脲治疗2型糖尿病疗效的系统评价

Glimepiride versus glibenclamide treatment of type 2 diabetes mellitus:A systematic evaluation

目的系统评价格列美脲与格列本脲治疗T2DM的疗效。方法计算机检索PubMed、万方等数据库从建库至2010年12月间的有关文献。按Cochrane系统评价的方法评价纳入研究的质量,使用Review Manager4.2软件进行荟萃分析。结果共纳入9个随机对照试验。结果显示:格列美脲在降低HbA-1c[P=0.08,加权均数差(WMD)=0.18,95%CI(-0.39,0.02]、FPG[P=0.06,WMD=0.46,95%CI(-0.94,0.01)]、餐后血糖[P=0.73,WMD=-0.16,95%CI(-1.08,0.76)]、TC[P=0.22,WMD=-0.2,95%CI(-0.51,0.12)]和TG[P=0.06,WMD=-0.30,95%CI(-0.61,0.01)]方面与格列本脲无差异;在相同血糖水平下,格列美脲组FIns[P<0.05,WMD=-0.83,95%CI(-1.21,0.45)]及餐后胰岛素[P<0.05,WMD=-5.94,95%CI(-8.79,-3.10)]升高程度低于格列本脲组;低血糖发生率格列美脲组低于格列本脲组[P<0.05,RR=0.66,95%CI(0.53,0.81)];在降低BMI方面格列美脲优于格列本脲[P=0.02,WMD=-1.49,95%CI(-2.7,-0.27)]。结论与格列本脲相比,格列美脲在降低血糖的同时,还能改善胰岛素抵抗及减轻体重,且低血糖发生率低,是安全有效的治疗T2DM的药物。

Objective To assess glimepiride versus glibenclamide treatment of type 2 diabetes mellitus （T2DM）. Methods We searched the literatures from PubMed, Wanfang and other databases. Evaluating the quality of the study was performed according to Cochrane systematic reviews, and Metaanalysis was completed by software Review Manager 4. 2. Results Nine RCTs （randomized control trials） were included in the analysis. There were no differences between two groups in decrements of glyeosylated hemoglobin[P = 0.08, the weighted mean difference （WMD） = - 0. 18,95 %CI（ -0. 39,0. 02） ], of fasting plasma glucose [P=0. 06,WMD=-0. 46,95%CI（-0. 94,0. 01）] and postprandial plasma glucose [P=0. 73,WMD=-0. 16,95%CI（-1.08,0. 76）], of cholesterol[P=0. 22,WMD=-0. 2 ,95%CI（-0. 51, 0. 12）] and of triglyceridel[P=0. 06,WMD=-0. 30 ,95%CI（-0. 61,0. 01）7. Under the same glucose level, glimepiride showed less increment of both fasting plasma insulin [P~ 0. 05, WMD = - 0. 83,95 % CI （ - 1.21, 0. 45）1 and postprandial plasma insulin[P^0. 05,WMD=-5.94,95%CI（-8. 79,--3. 10）1 than glibenclamide . There was a lower incidence of hypoglyccmaia[P〈0. 05,RR=0. 66,95%CI（0. 53,0. 81）1 in glimepiride group than in glibenclamide group. Glimepiride had less increment of BMI[P= 0.02,WMD = - 1.49,95%CI（- 2. 7, -0. 27）] than glibenelamide. Conclusion In comparison to glibenclamide, glimepiride can not only reduce blood glumse,but improve insulin resistance0 It can also reduce body weight increment and has less hypoglycemia.